Disability, participation and exercise

Professor Nora Shields will be sharing her extensive knowledge on physical activity among
people with a disability at the annual VIC Winter Breakfast this July.

‘I’ve always been an active person and a strong believer in the
importance and the effectiveness of exercise as a treatment
approach. When I started to work in Australia with people with
disability and families that included a person with a disability,
it got me hooked’ Nora Shields says enthusiastically.

Her CV includes a PhD from Trinity College in Dublin, followed by
over 12 years of research on disability and exercise culminating in
her current role as Professor in Clinical and Community Practice
(Allied Health, Northern Health) at La Trobe University.

A great deal of Nora’s early work involved qualitative research, an
experience that she says has been invaluable to her development
as a researcher.

‘Quite often in physio we don’t use qualitative research or consumer
input enough to inform our research, but I think that’s changing,
especially with the NHMRC [National Health and Medical Research
Council] guidelines about consumer participation.’

One particularly insightful finding of her earlier research was that
many young people with an intellectual disability exercise for social
reasons, as well as for health, meaning that a support person is a
critical part of their exercise routine.

‘This really helps us to create behaviour change for some of those
populations,’ Nora reflects.

Nora and her team conducted studies that matched student
physiotherapy mentors with young people with a disability to
encourage participation in exercise. Four trials conducted since
2008 showed the scheme created a ‘win-win’: the young people
with a disability participated in more physical activity and the student
physiotherapists gained experience working with diverse populations.

Many young people with an intellectual disability exercise for social reasons, as well as for health, meaning that a support person is a critical part of their exercise routine.

‘We may forget that physiotherapy students may not necessarily have met a person with disability in their life. In some respects, they’re
probably more like the general population than we anticipate,’
Nora says.

The program, called Fit Skills, is now run at La Trobe University in
Melbourne with the hope of scaling this up in the future.

Fortunately, the NDIS offers potential for participants to incorporate
physical activity programs into their plans, with positive repercussions
on ideas around intervention and benefits of physical activity.
However, Nora reminds physiotherapists that they need to be claiming this space early given the
profession’s expertise in this area.

‘We really are the physical activity
champions, but we need to make
sure that we step up to the plate.’

The last four to five years of Nora’s
work have involved research
translation projects in four
Australian states. The projects aim
to increase clinicians’ uptake of
evidence-based practice through
multifaceted knowledge translation
strategies. Strategies have included
‘knowledge brokers’ who are experts respected by others in their field,
e-evidence libraries and an outcomes database.

Nora hopes that her presentation at the VIC Winter Breakfast raises
new considerations for physiotherapists, including how their current
perceptions of participation fit with notions of impairment.

‘We’re really good at looking at physical function and activity, but it’d
be great to see this brought into the realm of participation.

‘The other thing that’s really important to challenge is the notion that
we now have young people with disability who are growing up and
becoming adults with disability and they’ve got very different needs to
other adults in rehabilitation. Their condition may be lifelong, but it’s
not static.’

She thinks physiotherapists can challenge current models of care to
account for this experience of living with a disability.

‘As physios we need to challenge the model of care that we have in
rehab, because right now our health system is not set up to look after
the needs of young people who grow into adults with a disability.
I’d like to see more physiotherapists challenge the health model
and think about it from a prevention point-of-view.’

Nora is also hopeful that after hearing her presentation, more
physiotherapists will consider a career in the disability arena.

‘I do work in an area that’s challenging but that’s the thing that I
enjoy. If nobody takes up the challenge, then you’ve got a group
of people who don’t have the research evidence base that helps
professionals—and everybody has the right to evidence-based care.’

Earlier this year, non-for-profit organisation Scope launched its first specialised physiotherapy service for rural Victorian children - GoKids Mobility Service. Dr Jennifer Fitzgerald, APAM, speaks about the dream that became reality.